Something that preoccupies me these days is the puzzle of sharing psychological science in accessible, interesting ways without undermining its complexity. This is isn’t a new problem – many brilliant people have been working on it for a long time. There’s been substantial progress, even when it’s hard to compete with the attention paid to public-facing psychologists who sacrifice accuracy for various incentives (see Ali Mattu for an excellent example of someone not sacrificing accuracy for engagement). Still, there’s a core challenge that keeps running through my mind that’s not fixable through improving technology or reducing jargon or changing incentives. It’s that there’s rarely (ever?) a one-size-fits-all (or even-a-vast-majority-fits-all) situation in psychology due to variability between situations and people (which Sanjay Srivastava wonderfully captured when he deemed psychology the hardest science).

One way that people get therapeutic-like info out to the public is through the kernels-of-wisdom model (e.g., a tweet, a meme, or Instagram photo with a message like, remember that you’re trying as hard as you can and that’s good enough). This model is appealing because it’s low cost and could be just enough to brighten up someone’s day or spread some insight (by the way, check out Anna Ropp‘s awesome, scientifically-informed Psych Tidbits Instagram account). No one’s under the illusion that it would replace therapy or other bigger life factors related to one’s mental health, and it’s unlikely to harm anyone.

Then, there are more concerted efforts at advice-giving through videos, books, and social media with varying levels of credibility and scientific support. To oversimplify things, the advice is usually get yourself together or stop being so hard on yourself. So, herein lies my concern: I think people are bad at guessing which message applies to them. And while I don’t think a little-bit-of-wisdom type message here and there causes problems, I think there could be a negative cumulative effect of repeated messaging out in the world that people should take one of these two approaches to improve their lives. For example, I’ve seen people who could use the message about not being too hard on themselves absorb the one about getting themselves together and consequently pushing themselves even more to the brink. Meanwhile, there are people who could improve their lives by pushing themselves in certain ways but avoid that by telling themselves they’re just engaging in self-care. And I’m sure I’ve done both at times; it’s human nature to find justifications for the thing we already want to do.

I’m slowly funneling to a specific example, which is this: advice that is often given, including by psychologists, is to give people the benefit of the doubt. This appeals to me in a number of ways consistent with my values – it seems like a nicer, more hopeful, and less angry way to be. It’s consistent with the scientific framework of waiting to interpret something based on evidence instead of intuition. And it’s good advice if you’re the type of person who would otherwise lean toward hostile attributions. On the other hand, consistently giving people the benefit of the doubt has costs that I rarely see acknowledged:

-It means questioning yourself a lot more when you sense that someone intends harm, which can erode your ability to trust your own perceptions.

-Without a belief that you can accurately assess and interpret situations, you can get stuck in a state of inaction rather than moving to resolve an issue.

-It can mean ignoring ambiguous, but existent warning signs that would have removed you from a dysfunctional situation earlier.

-If you’re prone to self-doubt, it may lead you to feel foolish for assuming good will in the first place. This is taxing and can affect productivity even once you’re in a better subsequent situation.

-People often trust cynics more than recurrent benefit-of-doubt-givers, as though they’re closer to truth when they assert their opinions. Cynicism is more likely to (erroneously) signal critical or deep thinking than benefit-of-doubt giving, which is typically linked to being naive or a pushover.

-A nontrivial number of people won’t reciprocate. It’s a good thing to assume the best in people in and of itself sometimes, but it’s also useful to strategically employ it with the hope of improving communication. Unfortunately, there are people who will take advantage of your approach while not extending any charitable interpretations to your behavior.

Despite every single cost I mentioned, I’d still argue that benefit-of-the-doubt giving is worthwhile and generally good advice to follow (perhaps because it’s aligned with my values or simply to justify my own past and future behavior). But, I’ve been reflecting on the costs more recently and thought writing them out might lead to hearing other people’s perspectives — so, I’m eager to hear what others think about the specific example or the broader issue of communicating universal psychology messages (but only if you mean well).*

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*I’ll assume you do.

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I went on Half Hour of Heterodoxy to talk about student reactions to political extremists giving speeches on college campuses. I was grateful for Chris Martin‘s interesting questions and wanted to expand on a few of the discussion points.

What’s the definition of trauma?

The DSM-5 defines trauma as exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways: 1) directly experiencing the traumatic event(s), 2) witnessing, in person, the event(s) or the event(s) as it occurred to others, 3) learning that the traumatic event(s) occurred to a close family member or close friend, 4) work-related repeated or extreme exposure to aversive details of traumatic event(s).

Do political extremists cause trauma when they speak on campus?

DSM-defined trauma is unlikely to occur at these events unless there’s actual or threatened violence involved (e.g., 1, 2,3,4). It’s important to avoid watering down the term trauma through misuse in situations where it doesn’t apply. However, fear of acute trauma doesn’t typically drive the opposition to political extremists on campus. The fear is that political extremists will use campus appearances to spread discriminatory beliefs that perpetuate social inequities. The sense of threat comes from historical knowledge about the uses of propaganda, and it’s amplified when violent acts are carried out that reference this propaganda (e.g., 1, 2, 3, 4). Some political extremists explicitly state that they’re trying to recruit college students to their causes (1, 2) and have developed strategies for persuading people through coded language (e.g., 1, 2, 3). Despite trauma being an unlikely consequence of these speeches, there is a robust literature showing that experiences of discrimination are related to worse mental and physical health (e.g., 1, 2, 3)* and that people can have physiological stress responses when exposed to discrimination and racism.** For example, it’s been proposed that these types of stress responses contribute to birth outcome disparities between Black and White women in the United States (e.g., 1, 2).

What should universities do?

1) Actions should be individually-tailored for the particular university and involve discussion with students and faculty, instead of something pushed top-down from administrators. Include mental health experts in these conversations.

3) Don’t equate mental health issues with weakness or confuse therapy with avoidance. Normalize discussions about mental health on campus. University-wide e-mails are sent around about flu shots and other medical issues – it can be helpful to do the same with mental health information and resources. When people seek counseling, the first step involves determining whether the person has a mental health problem. If a student refers to something as trauma when it’s not, therapists provide them with that valuable corrective feedback. There’s also a misconception that therapy is about unconditional reassurance or hand-holding, but it’s actually all about empowering people to face their problems skillfully.

A recent video by Natalie Wynn included a nuanced description of her response to Ricky Gervais telling transphobic jokes in his comedy specials. She made it clear that the thing that bothered her wasn’t that he’s allowed to tell those jokes (she’s a huge proponent of free speech) or even that the jokes are unoriginal, unfunny, or offensive. Rather, she’s afraid that he’s spreading untruthful ideas that make the world a harder place for people like her (she’s a trans woman). Her descriptions reflect the kind of complexity and clarity needed for productive conversations about the psychological effects of these types of speech.

*This paper describes the complexities of measuring discrimination in research.

I’ve learned a lot about First Amendment litigation from reading work by Ken White and FIRE.

I co-wrote a blog post on college mental health that you can access here.

Acknowledgments

In preparation for the podcast, I reached out to three people with relevant expertise and experience: Dr. Yessenia Castro, Linda Gordon, and Carly Marten. They generously shared research, articles, resources, and their thoughts with me. I’m thankful for how much they deepen my understanding of these issues and for all that they do to make the world a better place.

People who experience a similar event (e.g., trauma) can have disparate outcomes that depend on other factors (e.g., financial resources, societal views of survivors). This is called multifinality. Meanwhile, people with similar outcomes (e.g., posttraumatic stress disorder) can arrive there via distinct pathways (e.g., surviving sexual assault, a car accident, being the victim of gun violence). This is captured with the term equifinality.

I highly recommend this article by Beltz, Wright, Sprague, and Molenaar (2016) for detailed definitions of these terms:For example, imagine that a client gets diagnosed with obsessive-compulsive disorder (OCD). In order to figure out the best way to help, a therapist begins with nomothetic information (e.g., the diagnosis) to select a treatment. A randomized clinical trial suggests that a type of cognitive-behavioral therapy called exposure and response prevention (EX/RP) leads to significant improvement among 80% of people with OCD after 17 sessions. Based on available information, EX/RP is a good place to start. However, it’s possible that the client will be among the 20% of people who don’t respond to EX/RP. Therefore, therapists must also pay attention to idiographic information after initiating treatment (e.g., by regularly assessing the client’s OCD symptoms over time). If the client’s not responding to therapy, the idiographic data signal that the therapist must figure out why and make appropriate changes.

For more information on nomothetic and idiographic approaches, check out:

I’ve described frameworks that clinical psychologists use to understand people’s mental health needs at multiple levels while respecting their individuality. The dedicated people working hard to alleviate suffering in the face of these challenges give me hope for the future of the field.

When criticizing aspects of society, some people amplify their arguments by saying that those aspects cause suicide. Typically, the claim goes something like this, “____ is so bad that it leads people to kill themselves. Therefore, it’s urgent that we stop ____.” You should be skeptical when you hear these kinds of claims, because suicide is not reducible to simple explanations. It hurts to think about people grieving a suicide loss and then hearing that there was a simple fix all along. This is especially painful when there is little or no evidence that ____ substantially increases suicide risk. Additionally, if an empirically-weak claim receives enough public attention, limited suicide prevention resources can be squandered in the wrong places.

How to Evaluate Causal Claims about Suicide

Suicide is complex, and it’s extremely challenging to conduct research that yields results with causal implications. The closest we have to experiments may be randomized controlled trials designed to reduce suicidality. Keeping in mind that the majority of suicide research is correlational, here’s one set of criteria that you can use to evaluate whether ____ causes suicide.

2) covariation: If ____ causes suicide, then changes in ____ must accompany changes in suicide rates. I often see partial demonstrations where someone will say, “Here are higher suicide rates coinciding with more of ____,” but then leave out the necessary counterpart of establishing correlation: less of ____ should also be associated with lower suicide rates. Both are required to meet this criterion, and you don’t need experimental studies if you examine it through naturally-occurring differences. For example:

-Do demographic groups who experience more of ____ have higher suicide rates than groups with less of ____ over the same time period?

If the answer is “no,” then the covariation criterion has not been met.

3) nonspuriousness: If ____ causes suicide, then the relationship must persist even after ruling out alternative explanations. This criterion is arguably the most difficult to prove without experimental studies, but there are some correlational data that you’d expect to see if the claim is true. Questions to ask of such claims include:

Here‘s a strong example of someone evaluating an alternative explanation for an observed pattern using correlational data on a completely different topic (specifically, the part on self-censorship).

I wrote this post to share a framework for evaluating causal claims that I learned in grad school, and I hope that you find it useful. Even if it’s completely unintentional, when people use unsubstantiated claims about suicide to magnify societal concerns, it can feel exploitative of a group of people I care deeply about. Fortunately, this is outweighed by incredible, compassionate work reflecting the complexities and multiple pathways to suicide. I’ll link to some of my favorites below:

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In “Why I Do Not Attend Case Conferences,” Paul Meehl (1973) described reasoning errors that emerge during case conceptualization conversations among mental health professionals. One of the issues Meehl discussed at length (pp. 272-281) was an antinosological bias, defined as “an animus against diagnosis.” Here’s his response to a common objection to diagnostic labels:

Meehl described his style there as “highly critical and aggressively polemic,” which he justified by saying, “If you want to shake people up, you have to raise a little hell.” The second section has a much more constructive tone. Both sections are valuable, and I agree with his overall thesis that compassionate, effective mental health care requires clearheaded case conceptualization. Meehl is also correct that 1) meaningful diagnostic systems are crucial for advancing the field and 2) some critiques of the Diagnostic and Statistical Manual of Mental Disorders (DSM) reflect misunderstandings of the diagnostic process. I’ll discuss some of the major criticisms and benefits below.

However, we should also consider that appropriate diagnoses have helped people access beneficial services (e.g., children with intellectual disabilities or autism receiving accommodations in school and other public places). Additionally, the DSM specifically instructs clinicians to only assign diagnoses when a cluster of multiple symptoms: 1) causes clinically significant distress and/or impairment, 2) is persistent and severe for a length of time, 3) deviates significantly from developmental expectations, and 4) cannot be attributed to other factors (e.g., medical, cultural). These types of safeguards reduce the likelihood of pathologizing nonpathological behavior.

3. Classification decisions are made by people with conflicts of interest.

There have been some egregious examples of psychiatry researchers receiving large sums of money from pharmaceutical companies and not properly disclosing them. One instance is covered in a PBS Documentary and in this New York Times article:

In an effort to address this problem,DSM-5 panel members were required to disclose conflicts of interests. Cosgrove and Krimsky (2012) made a compelling case that further action was needed:

To be clear, psychiatric medications have helped numerous people and are warranted in particular circumstances. However, steps must be taken to reduce potential biases driven by the pharmaceutical industry.

Accurate diagnoses point to literature on the causes, correlates, and effective treatments for specific mental health problems. If an adolescent girl is accurately diagnosed with anorexia nervosa, we learn that she has an increased risk for bone fractures, arrythmias, depression, and suicide and should be monitored for each of these dangers. Importantly, we also know that family-based treatment is likely to be a good treatment option for her and that her parents can connect with parents experiencing similar struggles. To learn more about the process for evaluating levels of empirical support for therapies, look here for youth treatments and here for adult treatments.

4. Diagnostic labels enhance communication between treatment team members and aid continuity in care.

Diagnostic labels ease the transition for clients from one therapist to another (e.g., by saving them from having to repeat assessment procedures) and by communicating efficiently to other members of their treatment team (e.g., social workers, psychiatrists, physicians, clergy).

5. The DSM-5 has improved since the original version and has built-in mechanisms for change.

Despite the hindrances mentioned above, the DSM has formal, built-in processes for evolving with new scientific discovery. New versions are created with the explicit goal of making the classification system better reflect nature. Hyman (2010) argued that we should not reify existing diagnostic constructs. Instead, we must remember that diagnoses are constructed for clinical and scientific purposes. Therefore, improving the DSM requires openness to change and flexibility.

In conclusion, despite the concerns highlighted above, I agree with Meehl that antinosological biases impede progress and that mental health classification systemsshould be improved rather than abandoned altogether. I’m grateful for the dedicated clinicians and scientists working to deepen our understanding of mental health and feel encouraged by efforts to use that information to improve people’s lives.

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In an effort to keep this post relatively brief, I highlighted some main points and examples. Some of the more technical, in-depth things I’ve co-written about classification are linked below:

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There was so much going on in 2018 that I leaned on journalism, podcasts, and art more than usual to challenge, clarify, and enrich my understanding (and for comic relief too). I listed the most memorable of those things below, and I’d love to hear about your favorite things to read, listen to, and watch this year in the comments or on Twitter.